19.0736.01000
Sixty-sixth
Legislative Assembly HOUSE BILL NO. 1175
of North Dakota
Introduced by
Representatives Devlin, Holman, Kading, Vigesaa
Senators Bekkedahl, Heckaman, O. Larsen, Unruh
1 A BILL for an Act to amend and reenact section 43-17-01, subsection 9 of section 43-17-02,
2 sections 43-17-02.1 and 43-17-02.2, subdivision aa of subsection 1 of section 43-17-31, and
3 section 43-17-31.1 of the North Dakota Century Code, relating to regulation of physician
4 assistants.
5 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
6 SECTION 1. AMENDMENT. Section 43-17-01 of the North Dakota Century Code is
7 amended and reenacted as follows:
8 43-17-01. Definitions.
9 1. "Board" means the North Dakota board of medicine.
10 2. "Physician" includes physician and surgeon (M.D.) and osteopathic physician and
11 surgeon (D.O.).
12 3. "Physician assistant" means an individual issued a physician assistant license under
13 this chapter.
14 4. "Practice of medicine" includes the practice of medicine, surgery, and obstetrics. The
15 following persons must beare regarded as practicing medicine:
16 a. One whoA person that holds out to the public as being engaged within this state
17 in the diagnosis or treatment of diseases or injuries of human beings.
18 b. One whoA person that suggests, recommends, or prescribes any form of
19 treatment for the intended relief or cure of any physical or mental ailment of any
20 personindividual, with the intention of receiving, directly or indirectly, any fee, gift,
21 or compensation.
22 c. One whoA person that maintains an office for the examination or treatment of
23 personsindividuals afflicted with disease or injury of the body or mind.
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1 d. One whoA person that attaches the title M.D., surgeon, doctor, D.O., osteopathic
2 physician and surgeon, or any other similar word or words or abbreviation to the
3 person's name, indicating that the person is engaged in the treatment or
4 diagnosis of the diseases or injuries of human beings must be held to beis
5 engaged in the practice of medicine.
6 SECTION 2. AMENDMENT. Subsection 9 of section 43-17-02 of the North Dakota Century
7 Code is amended and reenacted as follows:
8 9. Any personAn individual rendering services as a physician assistant, if such service is
9 rendered under the supervision, control, and responsibility of a licensed physician.
10 However, sections 43-17-02.1 and 43-17-02.2 do apply to physician assistants. The
11 North Dakota board of medicine shall prescribeadopt rules governing the conduct,
12 licensure, fees, qualifications, and discipline, activities, and supervision of physician
13 assistants. Physician assistants mayare not be authorized to perform any services
14 whichthat must be performed by persons licensed pursuant to chapters 43-12.1,
15 43-13, 43-15, and 43-28 or services otherwise regulated by licensing laws,
16 notwithstanding the fact that medical doctors need not be licensed specifically to
17 perform the services contemplated under such chapters or licensing laws.
18 SECTION 3. AMENDMENT. Section 43-17-02.1 of the North Dakota Century Code is
19 amended and reenacted as follows:
20 43-17-02.1. Physician assistant - Limitations on prescribing drugsScope of practice.
21 1. A physician assistant may prescribe medications as delegated to do so by a
22 supervising physician. This may include schedule II through V controlled substances.
23 A physician assistant who is a delegated prescriber of controlled substances must
24 register with the federal drug enforcement administration.:
25 a. Provide a legal medical service for which a physician assistant is prepared by
26 education, training, and experience and is competent to perform, including:
27 (1) Obtaining and performing a comprehensive health history and physical
28 examination;
29 (2) Evaluating, diagnosing, managing, and providing medical treatment;
30 (3) Ordering, performing, and interpreting a diagnostic study and therapeutic
31 procedure;
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1 (4) Educating a patient on health promotion and disease prevention;
2 (5) Providing consultation upon request; and
3 (6) Writing a medical order;
4 b. Obtain informed consent;
5 c. Supervise, delegate, and assign therapeutic and diagnostic measures to licensed
6 or unlicensed personnel;
7 d. Certify the health or disability of a patient as required by any local, state, or
8 federal program;
9 e. Authenticate any document with the signature, certification, stamp, verification,
10 affidavit, or endorsement of the physician assistant if the document may be
11 authenticated by the signature, certification, stamp, verification, affidavit, or
12 endorsement of a physician; and
13 f. Pronounce death.
14 2. A physician assistant shall collaborate with, consult with, or refer to the appropriate
15 member of the health care team as indicated by the condition of the patient, the
16 education, experience, and competence of the physician assistant, and the standard
17 of care. The degree of collaboration must be determined at the practice which may
18 include decisions made by the employer, group, hospital service, and the credentialing
19 and privileging systems of a licensed facility. A physician assistant is responsible for
20 the care provided by that physician assistant and a written agreement relating to the
21 items in this chapter is not required.
22 3. A physician assistant:
23 a. May prescribe, dispense, administer, and procure drugs and medical devices;
24 b. May plan and initiate a therapeutic regimen that includes ordering and
25 prescribing nonpharmacological interventions, including durable medical
26 equipment, nutrition, blood and blood products, and diagnostic support services,
27 including home health care, hospice, and physical and occupational therapy;
28 c. May prescribe and dispense schedule II through V substances as designated by
29 the federal drug enforcement agency and all legend drugs;
30 d. May not dispense a drug, unless pharmacy services are not reasonably
31 available, dispensing is in the best interest of the patient, or an emergency exists;
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1 e. May request, receive, and sign for a professional sample, and may distribute a
2 professional sample to a patient; and
3 f. If prescribing or dispensing a controlled substance, shall register with the federal
4 drug enforcement administration and shall comply with appropriate state and
5 federal laws.
6 4. A physician assistant shall practice at a licensed health care facility, facility with a
7 credentialing and privileging system, physician-owned facility or practice, or facility or
8 practice approved by the board.
9 5. Notwithstanding subsections 2 and 4, a physician assistant with less than four
10 thousand hours of practice approved by the board under subsection 4 shall execute a
11 written collaborative agreement that:
12 a. Is between a physician and a physician assistant with less than four thousand
13 hours practice;
14 b. Describes how collaboration required under subsection 2 must occur; and
15 c. Is available to the board on request.
16 6. A physician assistant shall comply with any privileging and credentialing systems at
17 the facility at which the physician assistant practices.
18 SECTION 4. AMENDMENT. Section 43-17-02.2 of the North Dakota Century Code is
19 amended and reenacted as follows:
20 43-17-02.2. Physician assistant - Use of certain words or initials prohibited.
21 The terms "physician assistant" and "certified physician assistant" and the initials "PA-C"
22 may only be used to identify a person who has been issued a certificate of qualification by the
23 North Dakota board of medicine. A person who uses those terms or initials as identification
24 without having received a certificate of qualification is engaging in the practice of medicine
25 without a license.
26 1. A person that is not a physician assistant may not:
27 a. Represent oneself as a physician assistant or act as a physician assistant; or
28 b. Use any combination or abbreviation of the term or title "physician assistant" or
29 "PA" to indicate or imply the person is a physician assistant.
30 2. However, an individual who is not licensed as a physician assistant under this chapter
31 but who meets the qualifications for licensure as a physician assistant under this
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1 chapter may use the title "physician assistant" or "PA" but may not act or practice as a
2 physician assistant unless licensed under this chapter.
3 SECTION 5. AMENDMENT. Subdivision aa of subsection 1 of section 43-17-31 of the North
4 Dakota Century Code is amended and reenacted as follows:
5 aa. The failure to properly monitor a physician assistant, a fluoroscopy technologist,
6 or an emergency medical technician.
7 SECTION 6. AMENDMENT. Section 43-17-31.1 of the North Dakota Century Code is
8 amended and reenacted as follows:
9 43-17-31.1. Costs of prosecution - Disciplinary proceedings.
10 In any order or decision issued by the board in resolution of a disciplinary proceeding in
11 which disciplinary action is imposed against a physician or physician assistant, the board may
12 direct any physician or physician assistant to pay the board a sum not to exceed the reasonable
13 and actual costs, including reasonable attorney's fees, incurred by the board and its
14 investigative panels of the board in the investigation and prosecution of the case. WhenIf
15 applicable, the physician's or physician assistant's license may be suspended until the costs are
16 paid to the board. A physician or physician assistant may challenge the reasonableness of any
17 cost item in a hearing under chapter 28-32 before an administrative law judge. The
18 administrative law judge may approve, deny, or modify any cost item, and the determination of
19 the judge is final. The hearing must occur before the physician's license or physician assistant's
20 license may be suspended for nonpayment.
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Statutes affected: INTRODUCED: 43-17-01, 43-17-02, 43-17-02.1, 43-17-02.2, 43-17-31, 43-17-31.1
FIRST ENGROSSMENT: 43-17-01, 43-17-02, 43-17-02.1, 43-17-02.2, 43-17-31, 43-17-31.1
Enrollment: 43-17-01, 43-17-02, 43-17-02.1, 43-17-02.2, 43-17-31, 43-17-31.1